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Foodborne illness complaint form

Foodborne illness complaint form 2026

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The document is an Alleged Foodborne Illness Complaint Form designed for customers to report incidents of food-related illnesses experienced after visiting a specific store. It collects detailed information about the visit, including personal details, food consumed, symptoms experienced, and any medical treatment received. The form also outlines the process for reporting and forwarding the complaint to the appropriate corporate communications team.

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Click ‘Get Form’ to open the foodborne illness complaint form in the editor.
Begin by filling in the store number and location at the top of the form. This information helps identify where the incident occurred.
Enter the date and time of your visit, along with the names of employees on duty during that time. This section is crucial for tracing potential sources of contamination.
Provide your personal details, including your name, phone numbers (home and work), and address. This information allows for follow-up if necessary.
List any others in your party who may have been affected, along with details about the food consumed, including when and where it was eaten.
Document the onset of symptoms by specifying times and locations. Be thorough in listing all symptoms experienced.
If medical treatment was sought, include details about your doctor and hospital. This can assist health officials in their investigation.
Finally, ensure that you send a copy of this completed form to the designated contact as instructed at the bottom of the document.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What should you do in the case of a single complaint of food borne illness?

Report Food Poisoning If its an emergency, call 911. If you believe you or someone you know became ill from eating a certain food, contact your county or city health department. Reporting illnesses to your local health department helps them identify potential outbreaks of foodborne disease.

How do you handle a foodborne illness complaint?

Report it immediately to your local health department. Keep a detailed record of each complaint, including who made the complaint, contact information, the date of the communication and what symptoms they experienced.

How are foodborne illnesses reported?

State health departments typically receive and analyze routine disease surveillance reports, coordinate surveillance among the local health departments, and report cases of foodborne illness to the Centers for Disease Control and Prevention (CDC).

How are foodborne diseases reported?

The National Outbreak Reporting System (NORS) collects data electronically from state, local, and territorial public health agencies and includes reports of all outbreaks of enteric (intestinal) illness transmitted by food, water, animal contact, or by person-to-person contact that they investigated.

What is your first action when a customer complains about a foodborne illness?

Report the incident Be proactive and report the foodborne illness complaint to the government. Its your responsibility to ensure that the government is aware of any potential foodborne illness outbreaks.

How do I report a foodborne illness to the CDC?

CDC estimates 48 million people get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases each year in the United States.

How do public health departments track foodborne diseases?

Local environmental health services (EHS) and communicable diseases (CD) or epidemiology departments are usually the first to be notified of a foodborne disease outbreak. Depending on the nature and magnitude of the outbreak, state and federal agencies may also be notified and become involved.

Foodborne illness complaint form 2026

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